Complex Blunt Traumatic Abdominal Wall Hernias: A Review of Contemporary Management

Abstract

Traumatic abdominal wall hernias (TAWHs) present diagnostic and therapeutic challenges to trauma surgeons. Although rare, these injuries are frequently associated with high-energy mechanisms and underlying injuries. This review synthesizes contemporary evidence by integrating the Dennis grading criteria with the Harrell anatomic classification and subsequent management options. The Dennis classification stratifies injuries from grades I to VI, with low-grade injuries (I-III) managed non-operatively. High-grade injuries (IV-VI) rely on Harrell anatomic modifiers for management. Anterior and lateral defects carry high risk of intra-abdominal injury, often necessitating early surgical repair. Posterior lumbar defects exhibit lower visceral injury association, allowing safe observation or delayed repair. Grade VI injuries universally require emergent laparotomy. This combined severity and anatomic grading creates a unified management algorithm to guide the nuance of early, delayed, or minimally invasive repair. This structured approach differentiates candidates for urgent surgery from those suitable for non-operative management, optimizing outcomes in polytrauma patients.